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Войти в исследования European journal of medical research · 2025
Effect of different types of internal fixation on the incidence of femoral head necrosis in adult femoral neck fractures: a single-arm rate and network meta-analysis.
СтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод в очереди
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Du Chao, Li Teng-Shuai, Xue Hong-Fei, Cao Dong-Dong, Ye Yun-Tian, Guo Tian-Ci, Liu Ai-Feng
Аннотация
BACKGROUND: Osteonecrosis of the femoral head (ONFH) remains a devastating complication following internal fixation of femoral neck fractures (FNFs). Despite advancements in fixation techniques, the comparative efficacy among methods for mitigating this risk remains unclear.
OBJECTIVE: To compare the impact of various internal fixation methods on the incidence of femoral head necrosis in adult femoral neck fractures based on single-arm rate and network meta-analysis (NMA).
PATIENTS AND METHODS: PubMed, Embase, and Cochrane Library were searched (inception-September 2024). Eligible studies reported ONFH rates in adults treated with cannulated screws (CCS), dynamic hip screws (DHS), or femoral neck system (FNS). Single-arm rates were pooled via random-effects models; Bayesian NMA ranked interventions.
RESULTS: 52 studies (5649 patients) were included. Pooled ONFH rates were CCS 15% (95% CI: 0.13-0.18; I2 = 83.5%); FNS 12% (95% CI: 0.02-0.28; I2 = 51.2%), DHS 29% (95% CI: 0.20-0.39 1 study). NMA ranked FNS + CCS (SUCRA = 0.63) and FNS alone (SUCRA = 0.52) as optimal followed by DHS (SUCRA = 0.34), DHS + CCS (SUCRA = 0.33), and CCS (SUCRA = 0.52). Anatomical reduction (OR = 0.35; 95% CI: 0.21-0.56) and Garden I-II fractures (OR = 0.30; 95% CI: 0.21-0.41) significantly reduced ONFH risk.
CONCLUSIONS: Based on available evidence, FNS is associated with the lowest incidence of ONFH. These findings, derived predominantly from observational data, are hypothesis-generating and warrant confirmation by high-quality randomized controlled trials.
OBJECTIVE: To compare the impact of various internal fixation methods on the incidence of femoral head necrosis in adult femoral neck fractures based on single-arm rate and network meta-analysis (NMA).
PATIENTS AND METHODS: PubMed, Embase, and Cochrane Library were searched (inception-September 2024). Eligible studies reported ONFH rates in adults treated with cannulated screws (CCS), dynamic hip screws (DHS), or femoral neck system (FNS). Single-arm rates were pooled via random-effects models; Bayesian NMA ranked interventions.
RESULTS: 52 studies (5649 patients) were included. Pooled ONFH rates were CCS 15% (95% CI: 0.13-0.18; I2 = 83.5%); FNS 12% (95% CI: 0.02-0.28; I2 = 51.2%), DHS 29% (95% CI: 0.20-0.39 1 study). NMA ranked FNS + CCS (SUCRA = 0.63) and FNS alone (SUCRA = 0.52) as optimal followed by DHS (SUCRA = 0.34), DHS + CCS (SUCRA = 0.33), and CCS (SUCRA = 0.52). Anatomical reduction (OR = 0.35; 95% CI: 0.21-0.56) and Garden I-II fractures (OR = 0.30; 95% CI: 0.21-0.41) significantly reduced ONFH risk.
CONCLUSIONS: Based on available evidence, FNS is associated with the lowest incidence of ONFH. These findings, derived predominantly from observational data, are hypothesis-generating and warrant confirmation by high-quality randomized controlled trials.